FEATURED TECHNOLOGY: VELATM PROximAL ENDOGRAFT SYSTEm

The rapid acceptance of endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) over the past 15 years has been driven in large part by advancing endovascular skills, innovation in endograft technology, and physician expansion of the approach to patients with more complex anatomies.1 The challenges to EVAR remain, as is well documented in the clinical literature. Proximal neck morphologies such as reverse taper, short length, angulation, and presence of calcification or thrombus, have been shown to predict both acute and long-term complications following EVAR.2,3 Precise procedural positioning of the endograft, and the ability to establish reliable acute and chronic proximal seal represent practical daily considerations for endograft selection and case strategy. Since commercial introduction in 1999, the majority of traditional EVAR devices require the bifurcated component to establish both proximal fixation and seal through a combination of the stent radial force and active fixation elements (e.g., hooks, barbs). The flow divider of these bifurcated components is commonly positioned high in the aneurysm sac and experiences the peak axial4 and lateral5 forces that can affect proximal seal or device stability. Across these devices, delivery system mechanisms are highly manufacturer-specific. For example, the Medtronic Endurant® (Santa Rosa, CA) and Cook Medical Zenith® (Bloomington, IN) systems employ a “top-cap” style mechanism retaining the barb-bearing suprarenal sections of the stent graft until final deployment, whereas the Gore Excluder® C3® (Flagstaff, AZ) system relies on partial reconstrainability of the proximal infrarenal segment to enable multiple repositioning attempts.